This past weekend my brother told me of this diver earlier in July who was almost swallowed by the whale shark seen above. Immediately I googled the story and saw this CRAZY picture you see here - http://newsinabox.net/1721/whale-shark-photographed-when-almost-swallowed-a-man.html
Just as immediately, the dentist in me began to think of diving and related this story to MY work experience with diving. Who would have thought that dentistry and deep sea diving would be connected? While NO ONE in the world would want to be that young diver in the picture above - I learned this past week firsthand how divers and dentistry can be connected…
The other day I had a very nice patient come to our office with pain in his upper left jaw. He saw the hygienist for a cleaning and then I was asked to come in and evaluate the area and see what was happening. Even before seeing the patient my immediate assumption after hearing from the hygienist that he had a jaw problem was that he possibly had an infection, possibly had tension in his jaw due to trauma, or what was at the top of my list: that he had been clenching and grinding creating jaw pain. Nowadays I am more and more aware of wear on people's teeth from clenching and grinding ESPECIALLY in today's economy with no economic relief in sight and the need for a guard to help protect their teeth.
When I went in to check, it was not as I had suspected. He was healthy as a clam, no medications, and missing his upper left teeth – no clenching and grinding there! Then out of the blue he mentioned that he deep sea dived two weeks ago and he started noticing it getting worse after that. After he said that, it was as if a LIGHT BULB had gone on. AHA!!!!! Why?
Because deep sea diving = pretty extreme pressure changes! You’ve seen the movie The Abyss? Diving Pressure - yes! Human deep sea bottom dwellers - NO! As the diagnosis light bulb grew brighter in my head he said he remembered that when he had his tooth removed over four years ago that there had been a large hole in his sinus because the roots were very long and went right into his sinus cavity! Everything had healed but they had told him that he had a huge hole there after the extraction and they had packed it well and checked on him a few times after.
I had found my answer: his deep sea diving (and probably his flight home) had caused such extreme pressure changes that it had not allowed a complete equilibration of pressure in his sinuses. This increased pressure led to sinus inflammation and increased pressure in his gums! This even probably irritated the extraction site where there had once been a hole!
Now, for you (and for us dentists) it is GREAT to note that most of these communications will heal just fine on their own as long as the dentist/surgeon treats it appropriately (I will share more on this at another time). So why have pain NOW - years later after his extraction?
Perhaps he dove too deep and didn’t let everything equilibrate as slowly as he could. Perhaps he has allergies which cause inflammation of the sinus cavity – and that combined with the deep sea pressure and then the abrupt change in altitude with flying – all in combination irritated his sinuses. As you can see, while there is no ONE reason for this - there are MANY things to consider.
To help answer this: as a background - when you have teeth extracted in the upper left or upper right, towards your premolars and first molars sometimes the roots of those teeth can be VERY close, touching, or even EMBEDDED in your sinus cavity covered by a very VERY thin membrane. If this membrane is pierced or torn it exposes the sinus air cavities - allowing food, smoke, bacteria etc. a passage into your sinuses and drain into your nose and nasal passages leading to nasal inflammation, pain, and infection. NO ONE wants dinner from last night affecting their breathing. Yuck.
If this communication occurs it is called in the dental world: an oral-antral communication (aka: OAC) – a serious word that basically means a connection between your mouth and sinus cavity and it must be treated accordingly If it isn’t treated then an “oral-antral FISTULA” can be formed – a "tunnel" that is a PERMANENT link between the sinus and your mouth! If this occurs unfortunately the only option is surgery to close this link.
As I had said, most of these OAC’s heal just fine on their own. BUT like a scar on your skin, this area is weakened. So when you do various activities that involve changes in pressure or altitude (like flying or in this case deep sea diving AND flying), the sinuses CAN be affected! It is possible that he was only having pain on the left side of his jaw because that is the only area where his sinus had been perforated – weakening that area. Additionally if you have infection or sinusitis (inflammation) from sinus infections, this pressure can sometimes cause pain.
Lastly, something to consider is that after an extraction, most of us want to replace the tooth we are removing. It is important to know ahead of time, before the extraction, that the sinus cavities can expand and descend (a process called pneumatization) – sometimes descending too close to your bone and gums. This can make it very difficult to replace that tooth with an implant (or at least make the process of replacement MUCH longer and more involved than if you plan ahead of time). So PLAN AHEAD!
So what was I reminded from this experience?
1) Never jump to conclusions before you start a diagnosis (I had thought he was clenching and grinding when in fact he didn’t even have teeth in the area he was having pain)
2) Oral-antral communications can after an extraction and have long-term effects
3) Sinus inflammation & changes in sinus pressure can cause pain and even mimic tooth pain
4) Most importantly – I was reminded to ask medical history and listen when the patient tells you a background of the pain they are experiencing - such as if something happens AFTER an event. If this patient hadn’t told me that he had taken a recent trip and deep sea dived, I never would have considered that to be a connection to his pain and never been able to help him with his diagnosis
5) Lastly, I realized that patient’s life activities affect their teeth and oral cavity in ways I hadn’t imagined. I truly would LOVE to try deep sea diving sometime, and if I do - EQUILIBRATE!!!
image courtesy of: pichaus.com
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